One of the reasons the gender debate frustrates me so much is that I feel compelled to support (even, to believe!) in something before I am ready...
You are so brave to write this. I believe trans women are trans women. Women are a thing. Accept trans, especially if they make an effort to just be part of society without telling anyone what they must think or believe. I’m inclined to believe that some aspects of gender are culturally determined and some are biologically influenced due to biological differences. But I’m not going to argue all that much about it. But I will stick with the notion that humans are sexually dimorphic. Policies ought to consider impacts on natal women (or even natal men) if they are adversely impacted. IMHO
As a qualified physician, I sheepishly concur that the majority of Western medicine (and probably the other kinds too, in honesty) has been quackery, often harmful to the patients. In Mental Health slavish followers of Sigmund Freud were common until a few short years ago, so it is obvious we are still prone to non evidence based ideas, especially if they are presented to us by sympathetic or charismatic individuals, with a powerful institution (Ivy League College Med School or Hospital) giving its tacit blessing.
And so half the New England Journal of Medicine email updates I get now refer to health equity, diversity etc
Thank you for raising your head above the parapet of this toxic mess with your characteristic blend of civilty, reason and balance!
I find people get tangled up in the clinical definition of what constitutes an "illness" or "pathology." For instance, I have a heart condition that causes palpitations. My cardiologist said it doesn't actually constitute heart disease and can be classified as just a variation of a normal healthy heart beat. I understand that they have these clinical definitions for classifying whether something counts as a "disease," but I am under no illusions that this heart condition is anything other than defect. The peak model of heart health would not include this abnormality.
Lots of the things progressives are championing seem to me to revolve around an objection about what constitutes the "peak human condition." A society's conception of the peak human condition may be unjustly discriminatory and involve lots of stereotypes, excluding other races or women or other categories. But the notion of a peak human condition is essential to a productive and functioning society - you have to know what you want for your children. Trans people are not morally wrong and do not need condemnation, but gender dysphoria (in my view, regardless of what the DSM says) really is a deviation away from the "peak human condition." *If* we discovered that the way we were socializing our children was *increasing* their rates of gender dysphoria, I think it would be incumbent on us to re-evaluate what we're doing.
When people insist they know more than the available evidence demonstrates and categorically reject any dissent from their conclusion then the proper response is to refuse to go along.
As a child and adolescent psychiatrist who comes into contact with this every day, I thought I'd share a few thoughts off the back Sarah's piece. Disclaimer: these are personal observations based on the particular public mental health system I work in. They don't necessarily generalize.
At the moment I work in an adolescent inpatient mental health unit. I've recently crunched the numbers and over the last year, 12% of the teenagers that have come through our unit have been trans-identifying (compared to 0.5% in 2017). Of them, 100% have been girls, and the vast majority probably had Borderline Personality Disorder (BPD). Now I say 'probably' here because there's another dogma in adolescent mental health, that it's not OK to diagnose BPD in under 18s, even when it's clearly recognizable. This is wrong, but that's a rant for another time.
For the unfamiliar, BPD describes a constellation of personality traits, most commonly occurring in females. It's characterized by emotional dysregulation and "splitting" (adore you one minute, despise you the next). Probably as a consequence of these tendencies, self-harming and suicidal ideation are sadly quite common. Another key feature of this group is a “persistently unstable self-image”, which includes a tendency toward adopting some more striking personal identifiers. Think pink or green hair. Think piercings and tattoos. Once upon a time, these kids might have presented with 'multiple personality disorder'. At the moment, they're trans.
To be clear, this 12% of girls coming through my ward aren't there because they're trans and suffering from gender dysphoria. They're there for the reasons that girls with BPD frequently end up in hospital - self-harm, and overdoses. In the main, their trans identity isn't a cause of distress. Sometimes it's incidental. Sometimes it's something they flaunt and clearly enjoy the reaction it elicits. In fact, in my little corner of the system, actual Gender Dysphoria isn't something I'm seeing.
Despite what individual clinicians may say to me in private, the local policy is gender affirmation, and that's exactly what we do. We pounce on it. We amplify it. We place a significance on it that sometimes even the young person themselves don't. We tell their parents they'll do lasting harm to their suicidal teenager with anything short of total adoption. The vectors may be social media and schools, but there's little doubt in my mind; gender-affirming care is part of this pathology.
A depressing moment a month or two ago will serve as a snapshot of where we are in Australia, in terms of institutional capture. On a College open forum, somebody (a GP I think from memory) brought up the vexed topic of puberty blockers looking for advice.
A prominent and experienced Endocrinologist (ie hormone specialist) said that he felt some caution was appropriate rather than merely prescribing on demand to adolescent boys and girls. The response?
A Trainee Paediatrician jumped in calling him transphobic for using the words 'girls' and 'boys', demanded he be shut down/thrown off the forum for said thought crime, and appealed to some College policing authority for support. Probably this trainee has never even dealt with such patients but that was her shrill response anyhow.
Grim. Hardly anyone came to his defence.
I appreciate the seriousness with which you're approaching this. This has become a minefield for me, personally, as I am in a relationship with and discussing marriage with a transgender woman, all the while my MAGA culture warrior parents are starting to isolate themselves from me. I'm sure there are myriad reasons why people identify as transgender. I think that for some, there is possibly a genetic predisposition or something happening during fetal development. For others, perhaps something else entirely… attention seeking, self loathing, hypercuriosity, sexual fetishism, trauma or a whole host of psychiatric conditions… For each individual, I'm sure there's a different reason. And it should be OK to talk about all of them, without being condescending, dismissive, hateful, or rude about it. Let's just be real and honest about it. Unfortunately, activism ruins everything. And when you have activists on both the left and right pursuing an "all-or-nothing" jihad on this front, it leaves innocent people who actually do just want to live their lives and have honest, constructive dialog feeling crushed. In my girlfriend's case, I'm not going to conjecture what caused her to be transgender. She was raised that way. It's a pretty normal thing where she's from in the Philippines. It's tolerated, but perhaps not accepted. It was actually something very much appreciated before the arrival of the Spaniards and the christianization of most of the country, and the Spanish crown and Roman Catholic church, even after centuries, have not been able to fully eradicate it. So culture also perhaps plays a part in this. And we shouldn't be so arrogant as to think that the culture and traditions that are dominant in this country are perfect and cannot tolerate a little adjustment. Whatever the reasons for a person's identification as transgender, we can't lose sight of the fact that they are a human being. They have autonomy over their own life and their own body. They should not be molested or harassed or have any of their rights curtailed at all. And it doesn't matter the reason or the cause. Human rights are human rights, period. But the problem is that no one who is talking about this right now is arguing in good faith. On the left, they want to completely dismantle all social structures and build a whole new order (this is very Marxian), while on the right, they want to completely resist any and all flexibility in how our society deals with a seemingly increasing number of individuals that don't conform to their own expectations (which is counter to conservative instincts, which favor conformity to established institutions). I don't think we should do either. But there are no honest voices to be heard in any of these arguments. And I hate being in the crossfire of what I see as a mostly unnecessary battle in the Great American Culture War of the 21st Century™. Just listen to people. Find out how they feel. Try to relate to their experiences. Tell them your honest reactions. Have a real dialog. Expect to be offended. But discuss your offense openly and try to find out why it is you're offended rather than going on the attack or retreating into a safe space. Activism ruins everything. It's friendships, relationships… it's when people actually talk to each other and listen to each other in honest and respectful dialog that we make progress. Unfortunately, this seems to be as extant today as the dodo. The one thing I think would be very helpful to allow this to even happen, however, is to depoliticize it and take it out of the realm of public policy. Government intervention does as much harm as activism sometimes. We need less government from on high and more self government. Freedom of association. Freedom of thought. Freedom of life, liberty, property, and the pursuit of happiness. For all Americans—transgender, cisgender, or otherwise.
Any book(s) you would recommend which explain the gender ideologists' position in the best possible way.
Something I could read side by side with Kathleen Stock, Helen Joyce, Abigail Shrier, etc?
Gender dysphoria is a societal arising from societal problems, just at the belief in and search for witches sought out deviant people to blame for various eccentricities. It is unethical for medical doctors to assist in going "trans" for anyone under the age of 21. For those over this age, the doctor should recommend intensive psychiatry to get at the root of what is a mental problem, not a physical one. If someone wants to dress and act like the opposite sex, that is just fine. Let them play that role if it makes them happy. But to mortify the body with chemicals because someone has mental problems is unethical in the extreme.
This is a two sided coin with dual potentials for benefit and harm, similar to the technology of artificial intelligence. Therefore the needs are to proceed with this medical technology to exploit the benefit potential while also proceeding conservatively with procedural controls to avoid the potential harms.
People requesting medical transition should be evaluated carefully and skeptically, not affirmatively. Claims that delaying treatment of young people increases the number of suicides are not properly supported with evidence and therefore should not be determinative. Young people in particular are at higher risk of being harmed. Drugs and surgeries with long term negative impacts, such as infertility, should be restricted to people at least 18, or even 21, as there is much evidence that the common sense notion that younger people are more vulnerable to peer pressure than older people is substantial. For many sports male puberty provides a performance advantage. Sports competition for adults should accordingly continue to be segregated based on physical differences set during puberty that are significantly relevant to performance and that persist for some time, or forever, after medical transition. Naked people with a functional penis should be not be placed together with naked people with a vagina without the free consent of the latter. This is all common sense.
Activism married to ideology and profit making incentives are a substantial problem here. Incidents of ideological activists limiting and censoring relevant discussion for setting best practices are a warning sign that we there is an activist dynamic surrounding this issue that increases the risk of making mistakes. Counterfactual activists who insist otherwise should not prevail primarily because they are loud, demanding, intolerant, and employ various bullying tactics. Medical professionals need leeway to set best practices based strictly on the evidence with procedural controls to avoid being corrupted by financial conflicts of interest or by ideology. They may need government support with financing the collection of evidence, with enforcing procedural risk management controls, and with consumer and practitioner protections.
I've written a response post to this here:
I've tried to be thorough, it has ended up being a little long.
I expect I will only check back here once, in 3 weeks; if you want me to see a (public or private) comment before or after then, you can use the contact info on that same website.
I watched some of your videos expecting you to be just another conventional super progressive leftist but you are actually very nuanced and so unapologetically brave. You said exactly what I always thought but couldn't phrase myself. I no longer believe in gender. There is only biological sex and personality like you said. I still call people whatever pronouns they prefer out of respect but not because I believe in gender ideology.
I'm in an odd place on this issue. On one hand, I'm thrilled that trans people are not considered "freaks" anymore; I've never had a problem with acceptance since the mid 90s when I first learned what transgender is, a time when even hardcore liberals struggled to not respond to the subject with nervous laughter. On the other, there is a lot of pseudo-science and quasi-religious feeling and thought masquerading as enlightenment, and it's dug into the discourse with lightning speed and impressive thoroughness. I feel like every time something positive happens in society, there's some committee somewhere that has meetings on how to accompany it with something terrible and regressive.
Accept that people are different by default. Never accept that differences between people in any way entitles anyone to harm, abuse or exploit others.
Articulate and characteristically open and honest. You might recall I quite passionately disagreed with your assertion gender dysphoria is an illness. I am still forming my own thoughts. I think the main takeaway is people like Blaire White seem to thrive, be happy, and feel entirely at home in their transitioned body. So they're just doing what makes them happy, after all. I presume you'd at least agree with that? Also, as you yourself have said, hormones alter us all the way down to our brains, and if they are transitioned in their bodies and all the way down to their brains, surely it's clear they are not their original biological sex anymore? Blaire is precisely what most of us mean when we say a woman: a person with female facial structure, breasts, and female hormones. So, does it really make sense to say she's a man? I will grant you I've never seen you say that trans people are *not* the gender the identify as, but I'm curious what exactly your position is. For myself, to be honest, I sometimes feel so lost. People say gender is just a social construct. Ok, if it's a construct, what does it really mean to identify as male or female? I'm still forming my thoughts. Cheers.